4th. In these three the humerus and hand seem to have borne, as to length and size, a normal proportion to the stature of the indi viduals; but the forearms in all three were so much shortened, as not to exceed by one inch the measurement of the long axis of the hand.
5th. The lower extremity of the ulna in the three cases, instead of being on a level with the lower extremity of the radius, as it normally is, had passed lower down on the dorsum of the carpus from half an inch to one inch.
Besides these three cases of congenital luxation of the bones of the forearm back ward at the wrist-joint, Dr. R. Smith has, in his valuable work recently published, referred to two more specimens of the same malform ation. A cast of one of these specimens was preserved in the Museum of the Bristol In firmary, in August, 1836, when the writer and Dr. Smith visited that hospital, and the bones of the other specimen have been preserved' in the Museum of the Richmond Hospital.
The case of O'Neil presented in her left forearm the only example of which we have heard of congenital luxation of the bones of the forearm forwards (fig. 926.). In this case, also, it is to be remarked, that the forearm was preternaturally short.
Since the above observations were written I have seen other examples of congenital luxations of the wrist, in which the bones of the forearm were displaced backwards, and the carpus forwards, as in figs. 924. and 925. Sometimes the defect was single, or only af fected one forearm ; in others, the defect, if the paradoxical language be allowed, was sym metrical, affecting both wrists alike. A case of this last description was shown to me lately in the Downpatrick Infirmary, by the surgeon of the institution, Mr. Brabazon,
who was kind enough to present me with a cast, which I have in my possession.* This healthy young woman is the mother of many well-formed children, and feels but little in convenience from the malformation.
When speaking of the congenital defects of the elbow-joint, we noticed that the up per extremity of the radius often exceeded its normal length, so as to reach as high as the level of the olecranon process. (See ELBOW, Abnormal Condition of.) We may here remark, that the ulna as the result of congenital malformation, in almost all the specimens we have examined, of the congenital luxation of the wrist, has been at least half an inch lower down than the level of the carpal extremity of the radius. The reverse, however, of this I have lately seen, in a case of congenital luxation of the wrist, tinder Dr. M'Dowel's care, in the Whitworth Hos pital. In this case, of which Dr. Gordon has been kind enough to present me with a cast, the radius has, at its lower extremity, passed half an inch lower down on the back of the carpus than the ulna; varieties have been also noticed as to the carpus ; in some cases the bones of the carpus were not only malformed, but deficient in number ; in one case nine bones were found.
There are other congenital malformations of the wrist-joint which demand some attention from the physician and surgeon, such as affections of the wrist analogous to valgus, and cases of the foot and ankle, but we do not consider this the place to discuss these cases.
We may make the same remark as to those congenital defects of the hand with deformity of the wrist, which have been noticed to co incide with a deficiency in the brain on the side opposite to the deformity.